Early Renal-Replacement Therapy May Reduce the All-Cause Mortality of Severe COVID-19: An Observational Cohort Study

Qian, Jing; Wang, Mengjing; You, Huaizhou; Luo, Jianfeng; Li, Shengqing; Chen, Shu; Chen, Yijian; Li, Xiantao; Wang, Kangjie; Zhang, Weichen; Li, Yuan; Li, Ni; Chen, Jing

doi:10.1159/000524229

Cited by 4 publications

(4 citation statements)

References 49 publications

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“…A similar result was published by Xu [ 30 ]. This is in contrast to the study of Qian [ 31 ], where early initiation of RRT in COVID-19 patients with severe AKI signaled better prognosis. Nevertheless, the data in this field are inhomogeneous for both COVID-19- and non-COVID-19-related AKI [ 32 , 33 ].…”

Section: Discussioncontrasting

confidence: 99%

Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis

et al. 2023

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Acute kidney injury (AKI) is associated with impaired outcomes in critically ill COVID-19 patients. However, the prognostic significance of early AKI is poorly described. We aimed to determine whether AKI on admission to the intensive care unit (ICU) and its development within the first 48 h predict the need for renal replacement therapy (RRT) and increased mortality. An analysis of 372 patients with COVID-19 pneumonia requiring mechanical ventilation without advanced chronic kidney disease from 2020 to 2021 was performed. The AKI stages on ICU admission and Day 2 were determined using adapted KDIGO criteria. The early development of renal function was assessed by the change in AKI score and the Day-2/Day-0 creatinine ratio. Data were compared between three consecutive COVID-19 waves and with data before the pandemic. Both ICU and 90-day mortality (79% and 93% vs. 35% and 44%) and the need for RRT increased markedly with advanced AKI stage on ICU admission. Similarly, an early increase in AKI stage and creatinine implied highly increased mortality. RRT was associated with very high ICU and 90-day mortality (72% and 85%), even surpassing that of patients on ECMO. No difference was found between consecutive COVID-19 waves, except for a lower mortality in the patients on RRT in the last omicron wave. Mortality and need for RRT were comparable in the COVID-19 and pre-COVID-19 patients, except that RRT did not increase ICU mortality in the pre-COVID-19 era. In conclusion, we confirmed the prognostic significance of both AKI on ICU admission and its early development in patients with severe COVID-19 pneumonia.

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Section: Discussioncontrasting

confidence: 99%

Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis

et al. 2023

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“…On the other hand, Jing Qian and colleagues in 2021/2022, claimed that early CRRT can reduce the allcause in-hospital mortality in patients with severe COVID-19, but not improve multi-organ impairment or increase the risk of AKI. Early initiation of RRT merits an optional strategy in critically ill patients with COVID-19 (ChiCTR2000030773) (31).…”

Section: Resultsmentioning

confidence: 99%

Impact of CRRT on the outcome of critically ill Covid-19 infected patients with acute kidney injury. A retrospective observational cross-sectional study

Henein,

Abdelhamid,

Badawy

et al. 2023

Preprint

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Background: Numerous studies have postulated that Acute kidney injury in COVID-19 patients is significantly associated with an increased mortality (1,2). Continuous renal replacement therapy (CRRT) is the preferred modality of dialytic therapy in hemodynamically unstable COVID-19 patients who develop an acute renal failure. It is evident there is diversity in the number of patients who recover or survive after use of CRRT in these cases (3). Clearly, the decision to initiate CRRT in patients with COVID-19 acute kidney injury (AKI) should be individualized. Some earlier studies have reported that CRRT was associated with improved outcomes, including reduced intensive care unit (ICU) and hospital mortality, shorter duration of mechanical ventilation, and shorter ICU stays (8). On the other hand, others have claimed that CRRT improves renal function, but does not have impact on overall mortality (4). Objectives: Our aim was to study the association between the development of an AKI in COVID-19 patients and ICU stay as a primary endpoint and to study the influence of CRRT on the recovery of the renal function as secondary endpoints. Study Population Our study population had included all adult patients who were above 18 years old and were admitted to our ICU on the background of a laboratory confirmed COVID-19 infection who had developed an AKI during the ICU course according to AKIN criteria. Our included population should have had no previous history of chronic kidney disease or renal replacement therapy. Methods: Our study is a retrospective cross-sectional study, that was conducted during the period from June 2021 till the end of June 2022.All methods were run according to rules and regulations ethical, administrative, and scientific. Ethical and administrative approvals were taken from the assigned authority Research Ethical Committee Emirates Health Services (REC). Ethical committee approval is joined already. Informed consent from the legal guardians for all patients was taken already. All methods were performed in accordance in accordance with the relevant guidelines and regulations. Statistical analysis: All data have been collected and analyzed by the investigators using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software version 22. Results: A total of 108 COVID-19 patients with AKI were admitted to our ICU during the study period. We have identified a significantly increased ICU stay in CRRT group (Median 16 days) as compared to non-CRRT group (Median 4.4 days), P value was 0.00. Discussion: We have identified a significantly increased ICU stay in CRRT group (Median 16 days) if compared to non-CRRT group (Median 4.4 days), P value 0.00. Conclusion: We’ve concluded that the CRRT in Covid-19 patients with AKI is associated with increased ICU stay, even if the kidney function is improved

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“…Although most patients have mild or moderate disease, Omicron infection can progress to severe disease and result in acute respiratory distress syndrome, multiorgan failure and death ( Wu and McGoogan, 2020 ). Since early intervention was helpful to improve the prognosis ( Garcia-Del-Barco et al, 2021 ; Qian et al, 2022 ), early stratifying of patients based on disease severity is vital. CURB-65 is a commonly applied severity score in community-acquired pneumonia management, and it has also been previously validated in different populations of COVID-19 positive patients ( Nguyen et al, 2020 ; Artero et al, 2021 ; Elmoheen et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

A practical scoring model to predict the occurrence of critical illness in hospitalized patients with SARS-CoV-2 omicron infection

et al. 2022

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BackgroundThe variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged repeatedly, especially the Omicron strain which is extremely infectious, so early identification of patients who may develop critical illness will aid in delivering proper treatment and optimizing use of resources. We aimed to develop and validate a practical scoring model at hospital admission for predicting which patients with Omicron infection will develop critical illness.MethodsA total of 2,459 patients with Omicron infection were enrolled in this retrospective study. Univariate and multivariate logistic regression analysis were performed to evaluate predictors associated with critical illness. Moreover, the area under the receiver operating characteristic curve (AUROC), continuous net reclassification improvement, and integrated discrimination index were assessed.ResultsThe derivation cohort included 1721 patients and the validation cohort included 738 patients. A total of 98 patients developed critical illness. Thirteen variables were independent predictive factors and were included in the risk score: age > 65, C-reactive protein > 10 mg/L, lactate dehydrogenase > 250 U/L, lymphocyte < 0.8*10^9/L, white blood cell > 10*10^9/L, Oxygen saturation < 90%, malignancy, chronic kidney disease, chronic cardiac disease, chronic obstructive pulmonary disease, diabetes, cerebrovascular disease, and non-vaccination. AUROC in the derivation cohort and validation cohort were 0.926 (95% CI, 0.903–0.948) and 0.907 (95% CI, 0.860-0.955), respectively. Moreover, the critical illness risk scoring model had the highest AUROC compared with CURB-65, sequential organ failure assessment (SOFA) and 4C mortality scores, and always obtained more net benefit.ConclusionThe risk scoring model based on the characteristics of patients at the time of admission to the hospital may help medical practitioners to identify critically ill patients and take prompt measures.

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Early Renal-Replacement Therapy May Reduce the All-Cause Mortality of Severe COVID-19: An Observational Cohort Study

Cited by 4 publications

References 49 publications

Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis

Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis

Impact of CRRT on the outcome of critically ill Covid-19 infected patients with acute kidney injury. A retrospective observational cross-sectional study

A practical scoring model to predict the occurrence of critical illness in hospitalized patients with SARS-CoV-2 omicron infection

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